Background: Transversus abdominis plane (TAP) blocks provide postoperative pain relief after
various abdominal surgeries. Recently, erector spinae plane (ESP) block has obtained vast attention
due to its simplicity and usage in truncal procedures.
Objectives: This study aims to compare the ultrasound-guided bilateral ESP block versus bilateral
TAP block on postoperative analgesia after open total abdominal hysterectomy.
Study Design: A prospective, double-blinded, randomized, controlled, clinical trial.
Setting: Zagazig University Hospitals.
Methods: After ending of surgical procedure and before reversing of the muscle relaxant, 48
women were randomly allocated into 2 equal groups: erector spinae (ES) group received bilateral
ultrasound-guided ESP block with 20 mL of bupivacaine 0.375% plus 5 ug/mL adrenaline
(1:200000) in each side at the level of T9, and transversus abdominis (TA) group received bilateral
ultrasound-guided TAP block with the same volume of bupivacaine plus adrenaline.
Results: Visual Analog Scale scores at 30 minutes, 2, 4, 6, 8, 12, 16, 20, and 24 hours were
statistically significantly lower in the ES group compared with the TA group. The time for
requirement of first morphine was highly statistically significantly prolonged in the ES group (14.81
± 3.52 hours) compared with the TA group (10.58 ± 2.35 hours). The total amount of morphine
consumption in 24 hours postoperatively was statistically significantly decreased in the ES group; P
= 0.01. Incidence of postoperative nausea and vomiting was higher but statistically insignificant in
the TA group than the ES group. There were statistically significant numbers of unsatisfied patients
(4) in the TA group compared with the ES group (no patient).
Limitations: Sensorial evaluation of patients was not performed because both blocks had been
done under general anesthesia but did not affect outcome. Therefore we recommend further
studies comparing between both blocks.
Conclusions: Bilateral ultrasound-guided ESP block provides more potent and longer
postoperative analgesia with less morphine consumption than TAP block after open total
abdominal hysterectomy.
Key words: Abdominal hysterectomy, transversus abdominis plane block, erector spinae plane
block, postoperative analgesia
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